高贫困社区针对儿童的住房流动干预措施与青少年期后续精神障碍的相关性。
Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence.
机构信息
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
School of Education, University of California Irvine, Irvine.
出版信息
JAMA. 2014 Mar 5;311(9):937-48. doi: 10.1001/jama.2014.607.
IMPORTANCE
Youth in high-poverty neighborhoods have high rates of emotional problems. Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions.
OBJECTIVE
To perform an exploratory analysis of associations between housing mobility interventions for children in high-poverty neighborhoods and subsequent mental disorders during adolescence.
DESIGN, SETTING, AND PARTICIPANTS: The Moving to Opportunity Demonstration from 1994 to 1998 randomized 4604 volunteer public housing families with 3689 children in high-poverty neighborhoods into 1 of 2 housing mobility intervention groups (a low-poverty voucher group vs a traditional voucher group) or a control group. The low-poverty voucher group (n=1430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. The traditional voucher group (n=1081) received geographically unrestricted vouchers. Controls (n=1178) received no intervention. Follow-up evaluation was performed 10 to 15 years later (June 2008-April 2010) with participants aged 13 to 19 years (0-8 years at randomization). Response rates were 86.9% to 92.9%.
MAIN OUTCOMES AND MEASURES
Presence of mental disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) within the past 12 months, including major depressive disorder, panic disorder, posttraumatic stress disorder (PTSD), oppositional-defiant disorder, intermittent explosive disorder, and conduct disorder, as assessed post hoc with a validated diagnostic interview.
RESULTS
Of the 3689 adolescents randomized, 2872 were interviewed (1407 boys and 1465 girls). Compared with the control group, boys in the low-poverty voucher group had significantly increased rates of major depression (7.1% vs 3.5%; odds ratio (OR), 2.2 [95% CI, 1.2-3.9]), PTSD (6.2% vs 1.9%; OR, 3.4 [95% CI, 1.6-7.4]), and conduct disorder (6.4% vs 2.1%; OR, 3.1 [95% CI, 1.7-5.8]). Boys in the traditional voucher group had increased rates of PTSD compared with the control group (4.9% vs 1.9%, OR, 2.7 [95% CI, 1.2-5.8]). However, compared with the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%; OR, 0.6 [95% CI, 0.3-0.9]) and conduct disorder (0.3% vs 2.9%; OR, 0.1 [95% CI, 0.0-0.4]).
CONCLUSIONS AND RELEVANCE
Interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, PTSD, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes.
重要性：居住在高贫困社区的年轻人情绪问题发生率较高。了解邻里环境对心理健康的影响对于设计邻里层面的干预措施至关重要。
目的：探究针对高贫困社区儿童的住房流动干预措施与青少年时期后续精神障碍之间的关联。
设计、地点和参与者：1994 年至 1998 年期间，“向机会迈进”示范项目将 4604 户有 3689 名儿童的公共住房家庭志愿者随机分为 2 个住房流动干预组（低收入券组与传统券组）或对照组。低收入券组（n=1430）获得了搬到有增强流动性咨询服务的低贫困社区的券。传统券组（n=1081）获得了无地域限制的券。对照组（n=1178）未接受干预。10 至 15 年后（2008 年 6 月至 2010 年 4 月）对年龄在 13 至 19 岁（随机分组时 0-8 岁）的参与者进行了后续评估。应答率为 86.9%至 92.9%。
主要结局和测量：在过去 12 个月内使用经过验证的诊断访谈评估存在精神障碍，包括重性抑郁障碍、惊恐障碍、创伤后应激障碍（PTSD）、对立违抗性障碍、间歇性爆发障碍和品行障碍。
结果：在随机分配的 3689 名青少年中，有 2872 名接受了访谈（1407 名男孩和 1465 名女孩）。与对照组相比，低收入券组的男孩出现重度抑郁（7.1% vs 3.5%；比值比（OR），2.2[95%CI，1.2-3.9]）、PTSD（6.2% vs 1.9%；OR，3.4[95%CI，1.6-7.4]）和品行障碍（6.4% vs 2.1%；OR，3.1[95%CI，1.7-5.8]）的比例显著增加。与对照组相比，传统券组的男孩出现 PTSD 的比例也有所增加（4.9% vs 1.9%，OR，2.7[95%CI，1.2-5.8]）。然而，与对照组相比，传统券组的女孩出现重度抑郁（6.5% vs 10.9%；OR，0.6[95%CI，0.3-0.9]）和品行障碍（0.3% vs 2.9%；OR，0.1[95%CI，0.0-0.4]）的比例降低。
结论和相关性：鼓励搬出高贫困社区的干预措施与男孩中抑郁、PTSD 和品行障碍的发生率增加有关，与女孩中抑郁和品行障碍的发生率降低有关。需要更好地了解个体、家庭和邻里风险因素之间的相互作用，以指导未来的公共住房政策变化。
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